The Latest Information on Intracranial Atherosclerosis: Diagnosis and Treatment

Intracranial atherosclerotic stenosis (ICAS) is the most common cause of ischemic stroke in the world. ICAS is especially common in the Asian population accounting for 30-50% of all ischemic strokes. The risk of recurrent stroke in patients with symptomatic ICAS is the highest among the stroke subtypes. Two major factors associated with recurrent stroke are high degree (>70%) of stenosis and progression of ICAS. Transcranial Doppler ultrasound, CT angiography, MR angiography, and conventional catheter angiography are used for the diagnosis of ICAS. Today, high-resolution MRI can provide important information to improve the understanding of pathophysiology and diagnosis of ICAS. For prevention of recurrent stroke in patients with ICAS, surgery and endovascular intervention failed to show benefit over best medical treatment. Best medical treatment includes intensive risk factor control and antiplatelet therapy. Various antiplatelet drugs or their combination can be used for prevention of recurrent stroke in patients with ICAS. Cilostazol with or without aspirin is effective in preventing progression of symptomatic ICAS. Cilostazol is also safer than aspirin in terms of bleeding complications.